S CHANDLER1,2, L PURTELL1,3,4, I BERQUIER1, A BONNER1,5, H HEALY1,2, K HEPBURN1
1Kidney Health Service, Royal Brisbane And Women’s Hospital, Herston, Australia, 2Facilty Of Medicine, University Of Queensland, 3School Of Nursing, Queensland University Of Technology, Austalia, 4Research Development Unit, Caboolture Hospital, Metro North Hospital And Health Service, Caboolture, Australia, 5School Of Nursing And Midwifery, Griffith University, Australia
Aim: To evaluate how the COVID-19 pandemic affected kidney supportive care (KSC) referrals and care.
Background: Our health service re-designed delivery of the KSC service in response to COVID-19, including transitioning to a telehealth model and prioritising advance care planning (ACP).
Methods: Activity was audited over two three-month periods between 1 October-31 December 2019 (PRE-COVID-19) and 11 March-11 June 2020 (POST-COVID-19). Baseline demographics (age, gender), severity of kidney disease (eGFR, kidney replacement therapy [KRT]), patient functionality (resource utilisation groups ]RUG], Australian Karnofsky performance score [AKPS]), and reason for referral (advance care planning [ACP], decision making, symptom management, conservative management) were extracted from clinical records. Statistical analysis was performed in SPSS and included Chi square, independent T and Mann-Whitney U tests as appropriate.
Results: PRE-COVID-19 there were 29 referrals, with median age 73 (IQR= 17), eGFR 13 (IQR=7), 27.6% receiving KRT, mean RUG 5.76 (SD=2.3) and AKPS 56.52 (SD=12.03). There were 54 POST-COVID-19 referrals, median age 75 (IQR=12.75), eGFR 14 (IQR=8.75), 35.19% KRT, mean RUG 5.22 (SD=2.7) and AKPS 60 (SD=13.2). 92 patients were seen PRE-COVID-19 and 135 POST-COVID-19. PRE vs POST-COVID-19 results showed that 44.8% vs 63% (p=0.175) were referred for ACP, 13.8% vs 5.6% for decision making (p=0.382), 31% vs 18.5% for symptom management (p=0.308). Conservative management was indicated as the reason for referral, more frequently, pre-COVID compared to post-COVID (69% vs 29.6%, p=0.001).
Conclusions: Meeting the needs of this vulnerable group of patients was a priority of the health service as evident in the increased activity through the clinic. The types of activities shifted, with a focus on ACP via a telehealth model, without a significant change in the characteristics of patients.
Dr Shaun Chandler is currently undertaking specialist training to become a Nephrologist and General Physician. He is currently working at the Royal Brisbane and Women’s Hospital, with previous employment at the Logan Hospital and Princess Alexandria Hospital.